| NPI | 1568177988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ14926900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ14926900) |
| 363L00000X Nurse Practitioner (Licence: PA SP027614) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027614) | |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2025-07-06 |