| NPI | 1477906097 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00667900) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00667900) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-02-28 |