NPI | 1447428636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0012179) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP05281400) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2008-02-11 |
Last Update Date | 2022-07-21 |