| NPI | 1700504909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10886) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 113117) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2023-11-18 |