| NPI | 1962611376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26nj00013300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26nj00013300) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |