| NPI | 1336595800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00628000) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015756) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2020-07-24 |