| NPI | 1427296771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: NJ 26NJ00172800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 26NJ00172800) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 29NJ001172800) | |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2016-08-12 |