| NPI | 1154564284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 004113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 071318) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2023-03-08 |