NPI | 1215672118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01329200) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F349279-01) |
Enumeration Date | 2022-05-04 |
Last Update Date | 2024-05-24 |