| NPI | 1154196582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14934000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR21791000) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-10-03 |