| NPI | 1245259696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 332561) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ NN97049) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-08-16 |