| NPI | 1407644875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15306800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 356513) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |