| NPI | 1770048746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00875200) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP020207) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2019-05-10 |