| NPI | 1730536574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00638300) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NJ 26NJ00638300) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00638300) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-05-02 |