| NPI | 1609129691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00395100) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP-02506) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2023-05-05 |