| NPI | 1306849922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 002162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5019219) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-09-04 |