| NPI | 1134664717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01066000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR18553800) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2021-01-24 |