| NPI | 1821719410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 310921) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01361600) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2025-09-30 |