| NPI | 1700678661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 408890) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 873739) |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2026-07-09 |