| NPI | 1316577620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 806394) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R269240) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R269240) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405708) | |
| Enumeration Date | 2020-01-26 |
| Last Update Date | 2026-01-12 |