NPI | 1932704509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01104100) |
Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: NJ 26NR14799800) |
Enumeration Date | 2020-12-02 |
Last Update Date | 2022-10-16 |