NPI | 1073078457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 12712) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA RN2300344) |
Enumeration Date | 2019-02-10 |
Last Update Date | 2024-05-01 |