| NPI | 1255930129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26nj01085400) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022515) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2022-11-29 |