| NPI | 1356398895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00089100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA tp006694b) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-10-02 |