| NPI | 1992146872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402243) |
| Additional Taxonomies | 163WH0500X Registered Nurse, Hemodialysis (Licence: NY 635019) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2020-10-12 |