| NPI | 1295096584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00374300) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401462-1) |
| Enumeration Date | 2012-06-03 |
| Last Update Date | 2020-11-28 |