NPI | 1912591108 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ01121100) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ01121100) |
Enumeration Date | 2021-02-27 |
Last Update Date | 2023-02-15 |