| NPI | 1295576601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15079100) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NJ 26NJ15079100) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-11 |