| NPI | 1134585862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002205) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11002205) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00583200) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2025-06-27 |