| NPI | 1548516065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.005051) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.087299) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |