| NPI | 1205532801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404753) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY F404753) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 649309) | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-04-19 |