| NPI | 1124428032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201505351NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991347-NP) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2015-10-24 |