| NPI | 1770957466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9385424) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00802600) |
| 363L00000X Nurse Practitioner (Licence: NJ 26NR19782900) | |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2021-12-30 |