| NPI | 1922706902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F405002) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 717020) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2026-04-07 |