| NPI | 1891460614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01196900) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NJ 26NR12388600) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-12-13 |