| NPI | 1831188424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 400680) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 517707) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2015-04-03 |