| NPI | 1134714546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01208900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15639000) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2023-08-11 |