| NPI | 1003671850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406352-01) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15328900) |
| 163W00000X Registered Nurse (Licence: NY 682961) | |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2026-05-14 |