| NPI | 1518500768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 10335) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11004477) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 10335) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-02-23 |