| NPI | 1346893476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01009200) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309142) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01009200) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2021-02-10 |