| NPI | 1861342685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 688403) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F409159-01) |
| Enumeration Date | 2026-01-31 |
| Last Update Date | 2026-09-11 |