| NPI | 1679836985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347862) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00380800) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2271162) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2023-02-27 |