| NPI | 1972185221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01441100) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025538) |
| 363L00000X Nurse Practitioner (Licence: ME CNP211224) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-10-02 |