| NPI | 1760009062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 732427) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11014943) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403679) | |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2026-01-30 |