| NPI | 1770286668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01461700) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 11024787) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2024-06-24 |