| NPI | 1417459876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 25MP00459100) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MP00459100) |
| 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00459100) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 0211611) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 021611) | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2024-01-05 |