| NPI | 1427703115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405207) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 704440-01) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2023-12-02 |