| NPI | 1831617307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00754400) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26nj0075400) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-04-22 |