| NPI | 1497935142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405352) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 33 336007) |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NY 35 350259) | |
| Enumeration Date | 2007-11-10 |
| Last Update Date | 2024-06-12 |