| NPI | 1316467160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 60850) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R209965) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0101185-C-NP) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-03-21 |