NPI | 1306250071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00504000) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00504000) |
363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NJ 26NJ00504000) | |
363L00000X Nurse Practitioner (Licence: NJ 26NJ00504000) | |
Enumeration Date | 2014-06-20 |
Last Update Date | 2014-06-20 |