| NPI | 1942645544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00418900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY #33 338715) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00418900) | |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2023-01-23 |