| NPI | 1639918949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ15040500) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: PA SP030730) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2025-08-25 |