| NPI | 1861163370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 10782) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 778440) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404426) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2022-09-15 |