| NPI | 1548156169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F407049-01) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 714983-01) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |