| NPI | 1780448613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F405571-01) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F405571-01) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-03-26 |