| NPI | 1861245680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15011000) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: NJ 26NJ15011000) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |