| NPI | 1205293438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00617100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR13729800) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2024-11-05 |