NPI | 1326532938 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00832500) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343599) |
Enumeration Date | 2018-06-18 |
Last Update Date | 2019-08-15 |