| NPI | 1922558683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00755600) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR18070600) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: DE L1-0047476) | |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2024-01-08 |