| NPI | 1255423588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26NC08410800) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NR08410800) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |