| NPI | 1801592951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404805) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.180247) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 09190023) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 011631) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01472800) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR15624200) | |
| 163W00000X Registered Nurse (Licence: NY 668512) | |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2025-04-08 |