| NPI | 1932704509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01104100) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: NJ 26NR14799800) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2022-10-16 |