| NPI | 1801567656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01210900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR19538800) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-10-05 |