| NPI | 1548373384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00061900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100236700) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-09-25 |