| NPI | 1548383391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F331749-1) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NC09495600) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400454-1) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |