| NPI | 1427651371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 346958) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 408900) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 346958) | |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2026-08-07 |