| NPI | 1770858284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00516600) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP011989) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2022-01-05 |