NPI | 1447292495 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NO12213800) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00060200) |
Enumeration Date | 2006-06-12 |
Last Update Date | 2022-03-07 |