| NPI | 1619329166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 692184-1) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2022-12-27 |