| NPI | 1245659895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SF0001X Clinical Nurse Specialist Family Health (Licence: NY 334509) |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: NY 400905) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-04-10 |