NPI | 1194197921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00596800) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 26NJ00596800) |
Enumeration Date | 2015-10-20 |
Last Update Date | 2017-11-07 |