| NPI | 1174785208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 6282531) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 000386) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2010-04-12 |