NPI | 1992977854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NN08455200) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NN08455200) |
Enumeration Date | 2008-03-31 |
Last Update Date | 2018-08-23 |