| NPI | 1134568702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00398800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY F337685-1) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2018-08-08 |