| NPI | 1518018407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 40401751) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 510461) |
| 363L00000X Nurse Practitioner (Licence: NY 303836) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 303836) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 336957) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-07-08 |