| NPI | 1407235427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00555700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR08871000) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |