| NPI | 1609248665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00612900) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 307573) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2016-10-26 |