| NPI | 1740048610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15252600) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 353059) |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2026-02-17 |