| NPI | 1669803110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402638) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 672861) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2024-11-20 |