| NPI | 1790457208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 348070) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR18592200) |
| 163WE0003X Registered Nurse, Emergency (Licence: NY 675482) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01206800) | |
| Enumeration Date | 2021-10-03 |
| Last Update Date | 2021-10-18 |