| NPI | 1043945322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01342100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 832643) |
| 163W00000X Registered Nurse (Licence: NJ 26NR18929100) | |
| 363L00000X Nurse Practitioner (Licence: NY 350777) | |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-05-25 |