| NPI | 1104284835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015880) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN663483) |
| 163W00000X Registered Nurse (Licence: NJ 26NR17659800) | |
| 163W00000X Registered Nurse (Licence: NY 22 710754) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 33 340355) | |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |