| NPI | 1528467461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R214385) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00515700) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2016-02-04 |