| NPI | 1841720521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402408) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 717042) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2025-02-10 |