| NPI | 1811529415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403526-01) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 704435) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403526) | |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2022-03-07 |