| NPI | 1467671107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NN09442200) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F301050-1) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-08-11 |