| NPI | 1710694245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: NY 824656) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 824656) |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-03 |