| NPI | 1073893178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 306748) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306748) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26nj00337800) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2024-08-06 |