| NPI | 1801403027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01056600) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01056600) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2024-04-17 |