| NPI | 1083128417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01104500) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP018078) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2025-03-03 |