NPI | 1124490636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP017453) |
Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NJ 26NR16070800) |
251E00000X Home Health (Licence: NJ 26NR16070800) | |
Enumeration Date | 2015-10-22 |
Last Update Date | 2024-06-14 |