| NPI | 1457204513 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15528500) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ15528500) |
| Enumeration Date | 2026-02-18 |
| Last Update Date | 2026-07-31 |