| NPI | 1275143562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01064600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR17689800) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-11-26 |