| NPI | 1114587193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 8260) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 12.008260) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2020-04-02 |