| NPI | 1548586159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY f404772-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 626128) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2025-03-07 |