NPI | 1609149293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00480700) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA TAP002743) |
Enumeration Date | 2012-02-14 |
Last Update Date | 2016-05-04 |