| 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 |