| NPI | 1285145474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NR00754500) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NR00754500) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NR00754500) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2023-06-30 |