| NPI | 1184091902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307476-1) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00501000) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IA H140070) | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-10-02 |