| NPI | 1790346963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402685) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 696901) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-02-29 |