| NPI | 1568177988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP027614) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN533161) |
| 163W00000X Registered Nurse (Licence: NJ 26NR19103200) | |
| 363L00000X Nurse Practitioner (Licence: NJ 26NJ14926900) | |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2023-12-22 |