| NPI | 1710466842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01408400) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NJ 26NR19061100) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NJ 26NJ01408400) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2022-12-12 |