| NPI | 1538995998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406328-01) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR22638700) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 738786-01) | |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2024-09-12 |