NPI | 1043945322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01342100) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 832643) |
163W00000X Registered Nurse (Licence: NJ 26NR18929100) | |
363L00000X Nurse Practitioner (Licence: NY 350777) | |
Enumeration Date | 2022-07-20 |
Last Update Date | 2023-05-25 |