| NPI | 1801527650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01325800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95021345) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2024-01-26 |