| NPI | 1194125559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0991004-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WY 32684.1270) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2021-08-05 |