| NPI | 1003228594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403338) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 679006) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2022-03-24 |