| NPI | 1417301094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01158200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 340371) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404375) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-05-05 |