| NPI | 1326752684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12235) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 143925) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2026-04-24 |