| NPI | 1922332261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402014) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 17808) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NY 664292) | |
| 164W00000X Licensed Practical Nurse (Licence: NY 298173) | |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2020-10-19 |