| NPI | 1407026248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00151600) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00151600) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2023-02-22 |