| NPI | 1922346337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00410500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN227568) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2014-07-10 |