| NPI | 1518481100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017201) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00721000) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2022-11-08 |