| NPI | 1992459531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349186-01) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01278400) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 349186) | |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2022-08-25 |