| NPI | 1013609890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01476800) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ID 67044) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309560-01) | |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |