| NPI | 1548627599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F407257-01) |
| Additional Taxonomies | 101Y00000X Counselor |
| 163W00000X Registered Nurse (Licence: NY 910906) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2025-08-14 |