| NPI | 1518500768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 10335) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CT 10335) | |
| 363L00000X Nurse Practitioner (Licence: CT 10335) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2025-03-24 |