| NPI | 1902537632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01377500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020245) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-01-31 |