| NPI | 1740648922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 344327) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 670951) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 670951) | |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2019-07-16 |