| NPI | 1336653336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00805500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP018181) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2023-06-27 |