| NPI | 1972865897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 430476) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00386900) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 430476) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00386900) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2016-04-25 |