| NPI | 1245631332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402442) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F345244) |
| 163W00000X Registered Nurse (Licence: NY 691249) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2023-11-03 |