| NPI | 1912453788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ01131600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 710835) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F403449) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-04-03 |