| NPI | 1740785773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F404102-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 737804) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2022-09-01 |