| NPI | 1578604823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14902300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00411000) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 350690) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-10-14 |