| NPI | 1497421853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ01221300) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NJ 26NR22090400) |
| 163WG0000X Registered Nurse General Practice (Licence: NJ 26NR22090400) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2021-10-28 |