| NPI | 1972687895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA S0029322) |
| Additional Taxonomies | 111NR0400X (Licence: NJ MC00468600) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-08-13 |