| NPI | 1134556582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01364000) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 083630) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05571800) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2022-09-21 |