| NPI | 1972375996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ14954700) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311660) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-09-11 |