NPI | 1245984665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01265500) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01265500) |
363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ01265500) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ01265500) | |
Enumeration Date | 2022-02-04 |
Last Update Date | 2022-05-25 |