| NPI | 1497044408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402521-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 632195) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2018-11-08 |