| NPI | 1134643323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00749300) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 348383) |
| 363L00000X Nurse Practitioner (Licence: PA SP017943) | |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2023-11-29 |