| NPI | 1629489026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00494700) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: NJ 26NJ00494700) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2018-05-07 |