| NPI | 1245754175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0003109-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A129204) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2021-10-21 |