| NPI | 1194053777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 002910) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 2910) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2016-10-27 |