| NPI | 1689389868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310895) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 170263) |
| 163W00000X Registered Nurse (Licence: NY 639923) | |
| 363L00000X Nurse Practitioner (Licence: CT 10962) | |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-06-16 |