| NPI | 1366763336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00297100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA CRNP-SP010730) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11006252) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2024-06-12 |