| NPI | 1750543567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00602900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NR14073000) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-02-05 |