| NPI | 1114220142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00298700) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP010888) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2011-05-03 |