| NPI | 1366289100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15607800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR24301600) |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2026-08-05 |