NPI | 1942716444 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00769100) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0001203) |
Enumeration Date | 2017-12-19 |
Last Update Date | 2023-03-07 |