| NPI | 1578042362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 7723) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343373) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2023-06-03 |