| NPI | 1699097048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 004122) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 004122) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2015-05-14 |