| NPI | 1144452442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.005701) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3800-33) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2023-03-21 |