| NPI | 1427894690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP030337) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 354674) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15109800) | |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2024-09-03 |