| NPI | 1619412012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402422) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 341066) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2023-11-27 |