| NPI | 1700104098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 4651401) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 4651401) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-07-26 |