| NPI | 1457695835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405458) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306270) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00411200) | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2026-04-24 |