| NPI | 1285695486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F400927-1) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 484095-1) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2025-09-11 |