| NPI | 1871289520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01469600) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 26NJ01469600) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NJ 26NJ01469600) | |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-05-01 |