| NPI | 1750439774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00099500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 334234) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2015-03-24 |