| NPI | 1386340859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 11586) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 11586) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 11586) | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-07-30 |