| NPI | 1346920477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1151066) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1151066) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14883000) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2026-01-07 |