| NPI | 1255737631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 5841) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 285489) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5008751) | |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2017-03-03 |