| NPI | 1467761189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401353) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 582529) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2026-05-25 |