| NPI | 1235245614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO 990135) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 124732) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-09-22 |