| NPI | 1619705316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 13670) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2339810) |
| Enumeration Date | 2024-07-24 |
| Last Update Date | 2024-10-16 |