| NPI | 1811447501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00832600) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402047) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2025-01-22 |