| NPI | 1972743698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00260500) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NJ 26NJ00260500) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NY F305268-1) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: NY F340760-1) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: NJ 26NJ00260500) | |
| Enumeration Date | 2009-02-21 |
| Last Update Date | 2018-06-20 |