| NPI | 1982157236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406248) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431017) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2024-10-14 |