| NPI | 1609273481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00535800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 339326) |
| Enumeration Date | 2014-11-22 |
| Last Update Date | 2024-05-14 |