| NPI | 1750458949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CT E43179) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 00006) |
| 363L00000X Nurse Practitioner (Licence: CT 0006) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |