| NPI | 1497585558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15200100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR24153800) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-12-14 |