| NPI | 1023325172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00355700) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 336474) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00355700) | |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2022-12-30 |