| NPI | 1235667858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00843700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 731018-1) |
| 363L00000X Nurse Practitioner (Licence: NY 308269) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2018-10-10 |