| NPI | 1659683878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP8253) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 574003-1) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 401296) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2015-11-06 |