| NPI | 1063275550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406586-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 605826) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-03-19 |