| NPI | 1871841577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F405069) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 086771) |
| 1041C0700X Social Worker, Clinical (Licence: NY 084067) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 744382) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2024-11-04 |