| NPI | 1194197921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00596800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 26NJ00596800) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2017-11-07 |