| NPI | 1760978050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 656210) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-11-16 |