| NPI | 1619234382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00689900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP016182) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2021-12-22 |