| NPI | 1134643323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00749300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 348383) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 407327) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00749300) | |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2025-08-01 |