| NPI | 1972016301 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00777200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 26NJ00777200) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-03-17 |