| NPI | 1699309302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407127) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 012686) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2025-06-09 |