| NPI | 1336956390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15298700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9489315) |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2025-03-19 |