| NPI | 1235504309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NJ 26NJ00603800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00603800) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ00603800) | |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2017-03-28 |