| NPI | 1477078095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402672) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 708063) |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2019-07-24 |