| NPI | 1396768065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NN09318300) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA VP004634C) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-05-31 |