| NPI | 1164974812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00890300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR10490400) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2018-12-29 |