| NPI | 1124895248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ15008500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F351446) |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2024-07-24 |