| NPI | 1518352129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402432) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 620869) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2019-10-31 |