| NPI | 1326532938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00832500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343599) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2019-08-15 |