| NPI | 1629824834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 90060) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 90060) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2025-02-05 |