| NPI | 1619311966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: FL 3402612) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 73 027835) |
| 163W00000X Registered Nurse (Licence: FL 3402612) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2016-05-12 |