| NPI | 1629366398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 004680) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 004680) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2019-05-22 |