| NPI | 1902558364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01288700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR21318400) |
| 163W00000X Registered Nurse (Licence: PA RN636091) | |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-04-01 |