| NPI | 1083211239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01062100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01062100) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2021-07-14 |