| NPI | 1477896413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404224-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 667469) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2024-03-15 |