| NPI | 1881207595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CT 9126) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 9126) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 9126) | |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2023-01-09 |