NPI | 1780170092 |
---|---|
Former Name | SUPALKUMAR PATEL |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00964200) |
Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR16668400) |
Enumeration Date | 2018-07-10 |
Last Update Date | 2021-07-27 |