| NPI | 1083487698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407139) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 013311) |
| 163W00000X Registered Nurse (Licence: NY 90865401) | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-06-09 |