| NPI | 1932452703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist Adult Health (Licence: NJ 26NJ00393800) |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 261QU0200X Clinic/Center Urgent Care (Licence: NC 5010282) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2024-09-26 |