| NPI | 1871244723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 10333) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11026686) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2025-03-20 |