| NPI | 1841642204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 341521) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00818500) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 341521) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-09-29 |