| NPI | 1093330961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 8974) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2328798) |
| 163W00000X Registered Nurse (Licence: CT 169997) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: MA RN2328798) | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-12-06 |