| NPI | 1326661604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405371) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 676314) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308832) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2024-03-01 |