| NPI | 1770281677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01444100) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ01444100) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-12-02 |