NPI | 1467671107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NN09442200) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F301050-1) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2011-08-11 |