| NPI | 1841952538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11515252) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 764743-1) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403946) | |
| Enumeration Date | 2021-10-10 |
| Last Update Date | 2023-10-25 |