| NPI | 1629664131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-3926) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403143) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2023-06-27 |