| NPI | 1942665724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 755628) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY NYCPS-P-225) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2019-09-27 |