| NPI | 1306388970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407813) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR16679700) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2026-01-14 |