| NPI | 1649783010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26nj00770200) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NR18567000) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2021-11-12 |