| NPI | 1972337061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406768) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9555705) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 956089) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11037568) | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2025-04-02 |