NPI | 1104619113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ15333900) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 356747) |
Enumeration Date | 2025-05-23 |
Last Update Date | 2025-05-23 |