| NPI | 1063956381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993215-NP) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: CO APN.0993215-NP) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2022-07-21 |