NPI | 1306568084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01374200) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2022-09-19 |
Last Update Date | 2022-09-26 |