| NPI | 1306250071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00504000) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00504000) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NJ 26NJ00504000) | |
| 363L00000X Nurse Practitioner (Licence: NJ 26NJ00504000) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |