| NPI | 1528385747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: NJ 26NN07424400) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NY N-3895) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 307046) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2010-04-28 |