| NPI | 1356702203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00624600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 165625) |
| 363L00000X Nurse Practitioner (Licence: NJ 26NR10853600) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2024-05-30 |