| NPI | 1851455257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309641) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00123500) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-06-09 |