| NPI | 1134726722 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01070600) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 346338) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2021-03-14 |