| NPI | 1215473640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15036900) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA ap61306590) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404354) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022264) | |
| 163W00000X Registered Nurse (Licence: NY 725270) | |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2026-05-16 |