| NPI | 1851853535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F405802-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 766300) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2024-04-25 |