| NPI | 1447967559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 11156) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 11156) |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2024-03-21 |