| NPI | 1740926161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01304900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR20267500) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |