| NPI | 1194212522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01058500) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431391) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2024-11-19 |