| NPI | 1245089549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15088400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 779567-01) |
| 163W00000X Registered Nurse (Licence: NJ 26NR24113400) | |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-07-02 |