| NPI | 1962993675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00824700) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR15967000) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-07-17 |