| NPI | 1326863473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NJ 26nr20291200) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY f406920-01) |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2025-06-14 |