| NPI | 1770366171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14902900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NJ14902900) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 26NJ14902900) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 26NJ14902900) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-10-13 |