| NPI | 1598316002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345051) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15197700) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 14156) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2024-11-19 |