| NPI | 1306355755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ14906800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP017918) |
| 363L00000X Nurse Practitioner (Licence: NJ 26NJ14906800) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP017918) | |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2024-01-26 |