| NPI | 1194546630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ115184200) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: NJ 26NR13631900) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ15184200) | |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-11-08 |