| NPI | 1538834858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 348980) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 13563) |
| 207Q00000X Family Medicine (Licence: NJ F08210137) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-10-18 |