| NPI | 1639695091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402562) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 699520) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402562) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2025-11-19 |