| NPI | 1912578386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP026481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15477400) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ01182300) | |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2024-05-14 |