| NPI | 1992234942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403554) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 641751) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 341841) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-12-06 |