| NPI | 1437839321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11026930) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH23658) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F407540-01) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2025-11-17 |