| NPI | 1144523077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 5793) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 5793) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2014-10-16 |