| NPI | 1962462606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01177100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00645300) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2021-08-26 |