| NPI | 1225451172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405234) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 085481) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2025-03-25 |