| NPI | 1124567037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 353594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 725898) |
| 163W00000X Registered Nurse (Licence: FL RN9598500) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR23775000) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030882) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15074000) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2024-06-07 |