| NPI | 1154065423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10545) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 10545) |
| Enumeration Date | 2022-04-23 |
| Last Update Date | 2023-09-21 |