NPI | 1609248665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NJ 26NJ00612900) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 307573) |
Enumeration Date | 2015-10-29 |
Last Update Date | 2016-10-26 |