| NPI | 1649804576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 26NR17219300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01022000) |
| Enumeration Date | 2020-03-01 |
| Last Update Date | 2023-12-20 |