| NPI | 1942027958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ15205800) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15205800) |
| Enumeration Date | 2024-09-21 |
| Last Update Date | 2024-12-17 |