| NPI | 1912349390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F338168) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00811600) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2022-10-19 |