| NPI | 1356532386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402802) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 679575) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MD R178048) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-11-22 |