| NPI | 1639895691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 12208) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 33688) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 12208) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 12208) | |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2024-12-04 |