| NPI | 1992228829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402564-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR18701700) |
| 163W00000X Registered Nurse (Licence: NY 710928-01) | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2021-09-27 |