| NPI | 1659443125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400683) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012391) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2013-02-26 |