| NPI | 1184208894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2391993) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10001034) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00678300) | |
| 101YP2500X Counselor, Professional (Licence: DE PC-0011237) | |
| 101YP2500X Counselor, Professional (Licence: PA PC016597) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR24654600) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R270651) | |
| Enumeration Date | 2021-05-09 |
| Last Update Date | 2025-02-06 |