| NPI | 1669644670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10687) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 350086) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2023-04-03 |