| NPI | 1205177789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00445500) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: NJ 26nj00445500) |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2025-02-18 |