| NPI | 1558521971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00161300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009827) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |