| NPI | 1538749197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01136700) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR12830000) |
| 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ01136700) | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2021-12-30 |