Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA09150600 | NJ |
NPI | 1134370166 |
---|---|
Provider Name | Nathan Holmes |
First Address | Woodbury, NJ 08096-3499 |
Second Address | Woodbury, NJ 08096-3499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 21/10/2015 |