| NPI | 1114649167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01405300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR17524200) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-12-13 |