| NPI | 1003568841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 310415) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01244100) |
| 363L00000X Nurse Practitioner (Licence: CT 12.009763) | |
| 363L00000X Nurse Practitioner (Licence: FL 11013353) | |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-01-24 |