| NPI | 1144821158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 406511) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 739260) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: PA SP031005) | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2025-03-18 |