| NPI | 1730544115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00611500) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR11472300) |
| 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00611500) | |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2022-02-10 |