| NPI | 1396479010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997729) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0997729) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2025-05-20 |