| NPI | 1679282768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 11237) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 11237) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2022-11-17 |