| NPI | 1952685919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NJ 26NJ00584000) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: NJ 26NJ00584000) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2021-09-21 |