| NPI | 1447882253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01062200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01062200) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ01062200) | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2024-10-14 |