| NPI | 1780984153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401258-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 461868) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2018-03-17 |