| NPI | 1174016497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 626078) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 626078-1) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-09-06 |