| NPI | 1447885496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01029200) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR14935500) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2023-02-14 |