| NPI | 1386163053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402269) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 606082) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11011791) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2023-10-20 |