| NPI | 1255670790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F306162-1) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00423300) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2017-02-07 |