| NPI | 1831537372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26nj00440500) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00440500) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-07-07 |