| NPI | 1598795536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11024056) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 400555) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NC11014300) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2026-05-26 |