| NPI | 1447292495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NO12213800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00060200) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2022-03-07 |