| NPI | 1194051169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NJ 26NJ00088000) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: NJ 26NJ00088000) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2023-12-16 |