| NPI | 1356943245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01089400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15076300) |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2023-08-15 |