| NPI | 1144039413 |
|---|---|
| Professional Name | N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406706) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 804918) |
| Enumeration Date | 2025-01-02 |
| Last Update Date | 2025-03-04 |