| NPI | 1699301689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 345002) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2023-11-10 |