| NPI | 1881815694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ00048300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: VA 0024167356) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2015-12-15 |