| NPI | 1487726279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00337100) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: TN APN0000007422) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 18809) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-12-15 |