| NPI | 1356999627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00978500) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN703830) |
| 163W00000X Registered Nurse (Licence: DE LI0052682) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR20111300) | |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2020-02-06 |