NPI | 1528467461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R214385) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00515700) |
Enumeration Date | 2014-08-16 |
Last Update Date | 2016-02-04 |