| NPI | 1659895274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F406222-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 736096) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2024-09-27 |