NPI | 1336595800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00628000) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015756) |
Enumeration Date | 2016-05-13 |
Last Update Date | 2020-07-24 |