| NPI | 1154056000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0101613-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A170247) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-06-13 |