| NPI | 1861845737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00651500) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP016296) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2017-03-16 |