| NPI | 1033354014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401498) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 460673-1) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2020-05-18 |