| NPI | 1235947417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1186920) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15210000) |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-04-10 |