NPI | 1245259696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 332561) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ NN97049) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2014-08-16 |