| NPI | 1992521231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ5176300) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ5176300) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ5176300) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ5176300) | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2025-06-09 |