NPI | 1972185221 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01441100) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP025538) |
363L00000X Nurse Practitioner (Licence: ME CNP211224) | |
Enumeration Date | 2021-04-26 |
Last Update Date | 2024-10-02 |