| NPI | 1902131253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NY 431523) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 1162302) |
| 363L00000X Nurse Practitioner (Licence: NY 431523) | |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2023-06-30 |