| NPI | 1245016757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14910000) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ14910000) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2025-01-22 |