| NPI | 1750686978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP013901) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00311300) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP013901) | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2021-03-29 |