| NPI | 1730695917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 404512) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 724470-1) |
| Enumeration Date | 2017-12-24 |
| Last Update Date | 2023-03-14 |