| NPI | 1093599979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 12597) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CT 102928) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 12597) | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2024-03-04 |