| NPI | 1639651714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01390500) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 727968-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2023-08-14 |