| NPI | 1164833083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402922-01) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 338296) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2025-07-03 |