| NPI | 1770102634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11019688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ NJDCATEMP-000832) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2024-02-15 |