| NPI | 1871698498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400935) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F303888) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2009-09-01 |