| NPI | 1417979618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000262) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NN05967300) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-01-21 |