| NPI | 1366494361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00115800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 332578) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2015-10-10 |