| NPI | 1790220358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403532) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 716345-1) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2021-06-17 |