| NPI | 1093609406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 807392) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 8073912) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-09 |