| NPI | 1619176419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005604) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00136000) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5005604) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2016-06-02 |