| NPI | 1861260481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ14971900) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ14971900) |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2025-08-14 |