| NPI | 1760745889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00765600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR14180800) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-05-15 |