| NPI | 1609403922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 12.013832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2291576) |
| 363L00000X Nurse Practitioner (Licence: MA RN2291576) | |
| 146N00000X Emergency Medical Technician, Basic (Licence: MA E0910097) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-07-14 |