| NPI | 1578744314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F403033) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 273030) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2022-03-23 |