| NPI | 1881401875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP031439) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ15136200) |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2024-12-13 |