| NPI | 1356752562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00488900) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP013577) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00488900) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP013577) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2014-05-12 |