| NPI | 1376291013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01282100) |
| Additional Taxonomies | 251J00000X Nursing Care (Licence: NJ 26Nj01282100) |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2022-04-07 |