| NPI | 1255079711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 010663) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 349278) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2023-08-08 |