| NPI | 1134541733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407098) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 338235) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2026-03-22 |