| NPI | 1811976111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 3204) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA 285443) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2022-02-16 |