| NPI | 1114441102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00748700) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00748700) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2023-10-04 |