| NPI | 1821482597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00887200) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP014858) |
| 363LF0000X Nurse Practitioner Family (Licence: PA SP014858) | |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2019-04-29 |