| NPI | 1982102083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 8521) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 119709) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-167832) | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2019-10-15 |