| NPI | 1669869830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2303436) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00577800) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2016-08-16 |