| NPI | 1245984665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01265500) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ01265500) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ01265500) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: NJ 26NJ01265500) | |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-05-25 |