| NPI | 1316254683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402355) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR11657400) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00297600) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2018-08-27 |