NPI | 1306355755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ14906800) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP017918) |
363L00000X Nurse Practitioner (Licence: NJ 26NJ14906800) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP017918) | |
Enumeration Date | 2017-09-28 |
Last Update Date | 2024-01-26 |