| NPI | 1760127435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01303400) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01303400) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2025-07-22 |