| NPI | 1336626498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD475587) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: RI MD17353) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA10967600) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00975600) | |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2021-12-05 |