| NPI | 1467836882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NJ 26NJ00618600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR14518600) |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: PA SP020493) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: PA SP020493) | |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2020-10-16 |