| NPI | 1205168556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 33-341065) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 548615-1) |
| 163W00000X Registered Nurse (Licence: CT 083434) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 12.006746) | |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2020-04-07 |