| NPI | 1841002300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 16675) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.212557) |
| Enumeration Date | 2025-01-22 |
| Last Update Date | 2026-05-14 |