| NPI | 1457863227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15247500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9428924) |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2025-03-31 |