| NPI | 1891200424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ14878000) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: DE LP-0000232) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2024-08-26 |