| NPI | 1184388704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 013059) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 348579) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2024-04-23 |