| NPI | 1043927924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01392900) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR16957300) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-17 |