| NPI | 1528891140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407384) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NY 805277) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2025-10-16 |