| NPI | 1760869408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F403586) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 008076-1) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2021-09-08 |