| NPI | 1154693513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ00175500) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ00175500) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00175500) | |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2017-05-11 |