| NPI | 1285214015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01248200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NR19861900) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-09-17 |