| NPI | 1558554378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 348846-01) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NM R47553) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM R47553) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP01165) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NH 085700-23) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2022-04-28 |