| NPI | 1962872754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5019825) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR16099600) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00595100) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2024-07-15 |