NPI | 1619176419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005604) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00136000) |
363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5005604) | |
Enumeration Date | 2007-07-12 |
Last Update Date | 2016-06-02 |