| NPI | 1225644966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 9314) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 9314) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 9314) | |
| 163W00000X Registered Nurse (Licence: CT R50514) | |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2021-04-01 |