| NPI | 1447625785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 12.006412) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 90885) |
| Enumeration Date | 2015-12-12 |
| Last Update Date | 2016-11-29 |