| NPI | 1639181902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP011653) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA rn287482L) |
| 163W00000X Registered Nurse (Licence: NJ 26NR073233100) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP011653) | |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: NJ 26nc07323100) | |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: PA RN287482L) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-11-20 |