| NPI | 1790935377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ15206000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 589213-1) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2025-01-04 |