| NPI | 1124704598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ14873000) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405125) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 772936) | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-07-10 |