| NPI | 1982213997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 9280) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95029148) |
| 363L00000X Nurse Practitioner (Licence: MA RN2391405) | |
| 363L00000X Nurse Practitioner (Licence: NY 351723) | |
| Enumeration Date | 2020-07-26 |
| Last Update Date | 2026-02-19 |