| NPI | 1124490636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP017453) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NJ 26NR16070800) |
| 251E00000X Home Health (Licence: NJ 26NR16070800) | |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2024-06-14 |