| NPI | 1245800481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0101715-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0029135) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-03-21 |