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 |