| NPI | 1699067314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 004658) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: CT 004658) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2015-01-08 |