| NPI | 1356365522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 003272) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 3272) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-06-22 |