| NPI | 1063092112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26nj01130600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY f347235) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-04-13 |