| NPI | 1023520749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2324077) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2324077) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00771100) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP017896) | |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2023-02-02 |