| NPI | 1447561998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404267) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY 320082) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2023-04-21 |