| NPI | 1598025397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 11303) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26nj00395800) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00395800) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 346959) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2024-09-06 |