| NPI | 1811666126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 791295) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407024) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2026-02-05 |