| NPI | 1811364375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: NJ 26NJ00587000) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00587000) |
| 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: NY F431419) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431419) | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2020-12-02 |