| NPI | 1801124599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01081000) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 30 305107) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2022-03-11 |