| NPI | 1518448422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402612) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 342445) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2023-04-18 |