| NPI | 1033257241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00100300) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 26NJ00100300) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY F402808) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F334705) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00100300) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-02-10 |