| NPI | 1952119943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355500) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95026580) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15199000) | |
| Enumeration Date | 2024-12-21 |
| Last Update Date | 2025-03-10 |