| NPI | 1790927515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 408548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 6048801) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2026-06-22 |