NPI | 1124843503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 14447) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 164301) |
Enumeration Date | 2024-11-20 |
Last Update Date | 2025-02-25 |