NPI | 1487968095 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01417800) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209004124) |
Enumeration Date | 2010-08-06 |
Last Update Date | 2023-06-22 |