| NPI | 1417772286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15212500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F355443-01) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |