| NPI | 1487958971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00567400) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP011163) |
| Enumeration Date | 2010-12-27 |
| Last Update Date | 2024-08-14 |