| NPI | 1639428659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402111) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 723101) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 781326) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2024-01-24 |