NPI | 1225614274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01150900) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ NJDCATEMP-036966) |
Enumeration Date | 2021-03-21 |
Last Update Date | 2023-10-16 |