| NPI | 1386071710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CT 5512) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 5512) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2024-04-25 |