| NPI | 1912591108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01121100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01121100) |
| Enumeration Date | 2021-02-27 |
| Last Update Date | 2023-02-15 |