| NPI | 1902612948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15214900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F354921) |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2024-12-04 |