| NPI | 1235765587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01132300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 612057) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310210) | |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2022-03-02 |