| NPI | 1992258164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006992) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00675300) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY f340565) | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2025-07-14 |