| NPI | 1518587609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11034874) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ NJDCATEMP-007787) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2024-10-03 |