| NPI | 1609945567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 382084) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR17873700) |
| 163W00000X Registered Nurse (Licence: NY 541475) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NJ 26NJ15059700) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2024-07-25 |