| NPI | 1447148481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15349000) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 359556) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2026-05-26 |