| NPI | 1770779126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401805-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 278191) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2016-05-10 |