| NPI | 1316027642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00002000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NO09504400) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-06-29 |