| NPI | 1396329249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F354636) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 839723) |
| 163W00000X Registered Nurse (Licence: CT 145411) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 12699) | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-07-24 |