| NPI | 1326131954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F4018441) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F3028621) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-03-07 |