| NPI | 1568170140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 11234) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 11234) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 11234) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CT 11234) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 11234) | |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2022-11-12 |