| NPI | 1225409055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402467) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95030216) |
| 163W00000X Registered Nurse (Licence: NY 648473) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2026-05-06 |