| NPI | 1528554094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 8220) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 8220) |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2023-06-14 |