| NPI | 1013403849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 12.007701) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.124355) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2024-01-31 |