NPI | 1609129691 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00395100) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP-02506) |
Enumeration Date | 2012-10-16 |
Last Update Date | 2023-05-05 |