| NPI | 1750800934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00778700) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NJ 26NR15544800) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2020-09-26 |