| NPI | 1124435953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0991253) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 0194604) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2021-03-11 |