| NPI | 1033755921 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00989600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00989600) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2025-01-27 |