| NPI | 1104438746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 346420) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 672062) |
| 163W00000X Registered Nurse (Licence: NJ 26NR25197200) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15029400) | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2024-08-12 |