| NPI | 1730967654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15324400) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311279) |
| 363L00000X Nurse Practitioner (Licence: NJ 26NR15512300) | |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2026-05-26 |