| NPI | 1497271175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402312) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TN 173978) |
| 163WG0000X Registered Nurse, General Practice (Licence: NY 736219) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2019-05-09 |