| NPI | 1669839031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349130-01) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F407701-01) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2025-12-08 |