| NPI | 1801183827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 4697) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CT 075149) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2016-07-06 |