| NPI | 1487177366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01294100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP017626) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP017626) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP017626) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP017626) | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2025-06-26 |