| NPI | 1356970180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: NJ 26NJ01020000) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01020000) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ01020000) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ01020000) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2023-06-08 |