| NPI | 1295128791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00545900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00545900) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00545900) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2018-05-24 |