| NPI | 1932452703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: NC 5010282) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NJ 26NJ00393800) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2023-03-06 |