| NPI | 1447729058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R238002) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00878500) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2022-02-25 |