| NPI | 1447370317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: NJ 26NO10486300) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00054400) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |