| NPI | 1780147413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01007700) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NR13122000) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01007700) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2021-12-30 |