| NPI | 1790311587 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01024200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NJ01024200) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2024-12-16 |