| NPI | 1144622382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 339165) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 624738) |
| 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ01036100) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2025-01-10 |