| NPI | 1518674621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 26NJ01392700) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 350689) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01392700) | |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2024-02-21 |