| NPI | 1336770601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0098041) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0001870-C-NP) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2022-06-02 |