| NPI | 1497156418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403457) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F338939) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2023-05-23 |