| NPI | 1598193989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401869) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP013941) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307355) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP013252) | |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2024-02-19 |