| NPI | 1578381281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406449) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15158100) |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-12-16 |