| NPI | 1427179563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: CT R33924) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CT 000377) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |