| NPI | 1134743370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 153615) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO ANP.0994843) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |