| NPI | 1497188163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 005467) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 005467) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2017-01-18 |