| NPI | 1801048335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 003924) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2370792) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2022-12-19 |