| NPI | 1487785838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 002443) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 002443) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CT 002443) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-04-08 |