| 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 |