| NPI | 1033788237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: VT 101.0137520) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 009732) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2024-11-18 |