| NPI | 1194153262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP028181) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00461900) |
| 363LF0000X Nurse Practitioner Family (Licence: NY 338381) | |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2024-10-09 |