| NPI | 1649212697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401065) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY F320026) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-06-22 |