NPI | 1578604823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NJ 26NJ14902300) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00411000) |
363LF0000X Nurse Practitioner Family (Licence: NY 350690) | |
Enumeration Date | 2007-02-09 |
Last Update Date | 2024-10-14 |