| NPI | 1376113258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 347859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 727993-01) |
| 163W00000X Registered Nurse (Licence: NJ 26NR19943500) | |
| 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ01274800) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2023-01-25 |