| NPI | 1013801620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15344200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 357019) |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2026-03-26 |