| NPI | 1598913485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F335632-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 465453) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401408) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2012-01-10 |