| NPI | 1447654421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 689235) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2025-10-23 |