| NPI | 1275382897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ F02241222) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15966200) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2025-03-31 |