| NPI | 1619642287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ14870200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 348109) |
| Enumeration Date | 2021-08-15 |
| Last Update Date | 2024-06-25 |