| NPI | 1942743752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00679200) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ00679200) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2023-05-31 |