NPI | 1295250983 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0001770-C-NP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10459) |
Enumeration Date | 2017-08-03 |
Last Update Date | 2019-11-26 |