| NPI | 1043580707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 563386) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NY 563386) |
| 163WC0400X Registered Nurse, Case Management (Licence: NY 563386) | |
| 163WC1500X Registered Nurse, Community Health (Licence: NY 563386) | |
| 163WH0200X Registered Nurse, Home Health (Licence: NY 563386) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 563386) | |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-01-11 |