| NPI | 1831739903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CT 9243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 082854) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2023-01-10 |