| NPI | 1306517842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01207400) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 721329) |
| 163WG0000X Registered Nurse, General Practice (Licence: NJ 26NR19437900) | |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2022-03-08 |