| NPI | 1548416241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 003847) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT APRN 003847) |
| 363L00000X Nurse Practitioner (Licence: CT RN 075300) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2018-11-05 |