| NPI | 1598242133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: CT 12.011343) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: GA APRN-NP116957) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2025-10-09 |