| NPI | 1659815710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00695000) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: NJ 26NR12434400) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2018-06-07 |