| NPI | 1538953633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 15927) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 179050) |
| Enumeration Date | 2025-04-05 |
| Last Update Date | 2026-03-05 |