| NPI | 1922381375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00345500) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP011263) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2019-10-29 |