| NPI | 1629574637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00812800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM 64528) |
| 363LF0000X Nurse Practitioner Family (Licence: FL 11014255) | |
| 363LF0000X Nurse Practitioner Family (Licence: AZ 262907) | |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-06-03 |