| NPI | 1225764582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 10631) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 12.010631) |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2023-03-13 |