| NPI | 1841575552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00339200) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR13696200) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00339200) | |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2022-02-10 |