| NPI | 1851920508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NJ NJDATEMP-000486) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11034560) |
| 363A00000X Physician Assistant (Licence: AZ 10171) | |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2024-08-28 |