| NPI | 1861798977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 404189) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 005567) |
| 163W00000X Registered Nurse (Licence: NY 736330) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2022-07-08 |