| NPI | 1689448102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REPUBLIC REGISTERED AGENT LLC 732-930-1675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2023-12-15 |