| NPI | 1699230359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01103900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 344045) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2023-07-06 |