NPI | 1336653336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00805500) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP018181) |
Enumeration Date | 2017-11-29 |
Last Update Date | 2024-09-25 |