| NPI | 1437830494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14881800) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-06-11 |