| NPI | 1528932621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15370000) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407612) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 357946) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15370000) | |
| Enumeration Date | 2025-10-01 |
| Last Update Date | 2025-10-03 |