| NPI | 1609956549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 003498) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 003498) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2013-08-22 |