| NPI | 1033305578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00133000) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 305372-1) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2023-03-07 |