| NPI | 1912668229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP024915) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01253900) |
| Enumeration Date | 2022-01-08 |
| Last Update Date | 2024-05-14 |