| NPI | 1750008116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01348300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR16435200) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2023-06-01 |