| NPI | 1619425410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341571) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00712300) |
| 363L00000X Nurse Practitioner (Licence: CT 9226) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00712300) | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2024-11-08 |