| NPI | 1902862543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00143800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00143800) |
| 363LF0000X Nurse Practitioner Family (Licence: NY F333998) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2024-12-03 |