| NPI | 1255752382 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403618) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 672206) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2024-06-20 |