| NPI | 1326457557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 2021006449) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MS A810608) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0000647-C-NP) | |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2022-09-02 |