| NPI | 1972213783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404648-01) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 11604) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 090296) | |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2023-08-18 |