| NPI | 1013257740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00452500) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NJ 26NO10663300) |
| Enumeration Date | 2013-02-16 |
| Last Update Date | 2019-04-03 |