| NPI | 1225614274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01150900) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ NJDCATEMP-036966) |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2023-10-16 |