| NPI | 1063514289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400138) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 422413-1) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304374) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2015-07-14 |