| NPI | 1790524478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 708531) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NJ 26NR18049700) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-05-22 |