| NPI | 1982241535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403687) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 778902) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2021-08-24 |