| NPI | 1265733455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400966-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 11089101) |
| 163W00000X Registered Nurse (Licence: NY 22-542744) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2021-03-28 |