| NPI | 1972948073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406161) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: NY 692583) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2026-04-10 |