| NPI | 1639391543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NN08865000) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NO08865000) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NN08865000) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NN08865000) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-03-17 |