| NPI | 1831072800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15418700) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ AG12240079) |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-10-08 |