| NPI | 1922527993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00750500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NJ00750500) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-01-30 |