| NPI | 1154147486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15146000) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP030439) |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-01-13 |