| NPI | 1215672118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01329200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F349279-01) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2024-05-24 |