| NPI | 1982005047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 11317) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00492100) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2022-12-12 |