| NPI | 1477936094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26NR17077400) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: NJ 645058) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |