| NPI | 1366995128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00655800) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00655800) |
| 163W00000X Registered Nurse (Licence: NJ 26NR12673100) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2022-02-02 |