| NPI | 1477948578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027204) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR16635300) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP014671) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00578100) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00578100) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00578100) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP014671) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-05-22 |