| NPI | 1821178476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400794-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 011739-1) |
| 163W00000X Registered Nurse (Licence: NY 533159) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305760-1) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-03-01 |