NPI | 1013430065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00740000) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00740000) |
Enumeration Date | 2017-07-21 |
Last Update Date | 2017-07-21 |