| NPI | 1053988303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 891591) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 340837-01) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2024-05-03 |