| NPI | 1548522550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01210700) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310436) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-03-02 |