| NPI | 1568552826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 5510) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 005510) |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 5510) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2018-04-20 |