| NPI | 1316178791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00543300) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP010378) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2016-05-02 |