| NPI | 1750097150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NJ 26NJ14872400) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP027010) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2024-06-03 |