| NPI | 1437520848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406309) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 322091) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2024-10-11 |