| NPI | 1598207060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14860600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R201291) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R201291) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 351730) | |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2023-07-09 |