| NPI | 1104349984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 7299) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 2017003273) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-03-07 |