| NPI | 1528224714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 001801) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 001801) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2017-08-07 |