| NPI | 1952061616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 26NJ01249800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01249800) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2024-11-20 |