| NPI | 1295803633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R221879) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26N011085000) |
| 363L00000X Nurse Practitioner (Licence: PA RN603487) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00120700) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP010259) | |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2023-07-05 |