| NPI | 1710157961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJO1182500) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26no10656800) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2024-09-03 |