| NPI | 1851008544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404532) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: PA SP026115) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2026-04-03 |