| NPI | 1063944973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 26NJ00654000) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00654000) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00654000) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00654000) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-02-24 |