| NPI | 1841522398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2326087) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405612) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ14940700) | |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2024-01-31 |