| NPI | 1750764007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402677) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F339743) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2021-04-05 |