| NPI | 1346839024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404163) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 802060) |
| 163W00000X Registered Nurse (Licence: WA RN61526851) | |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2024-02-29 |