| NPI | 1699388728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10298) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CT 161300) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2022-08-16 |