| NPI | 1093024499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00305200) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 336530) |
| Enumeration Date | 2010-10-02 |
| Last Update Date | 2014-05-15 |