| NPI | 1568096576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15099500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F345628) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2026-03-04 |