| NPI | 1508734757 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15451400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 764840) |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2025-10-28 |