Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 271039 | NY |
N | 207P00000X | Emergency Physician | MA09905100 | NJ |
Y | 207RC0200X | Critical Care Medicine | 25MA09905100 | NJ |
N | 207RC0200X | Critical Care Medicine | 271039 | NY |
NPI | 1023336112 |
---|---|
Provider Name | Dr. Lars-Kristofer Nelson Peterson |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 08/04/2019 |