| NPI | 1376807040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0992626-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 564634) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2024-09-30 |