| NPI | 1811307945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 318297) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 781487) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407396) | |
| 251J00000X Nursing Care (Licence: NY 318297) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2026-09-29 |