| NPI | 1710041496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00123800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR12454700) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-01-17 |