| NPI | 1972247104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01308100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR16611700) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-05-23 |