| NPI | 1285228981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405580) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 771834-01) |
| Enumeration Date | 2021-02-23 |
| Last Update Date | 2025-07-22 |