| NPI | 1710296827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402733) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 635938) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2020-01-03 |