| NPI | 1588948244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00347700) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00347700) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2024-05-24 |