| NPI | 1972971240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY f34002501) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY f34002501) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F340025-1) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2026-02-05 |