| NPI | 1326713785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ14923300) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NJ 26NR25133100) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 765959) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405093) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-02-16 |