| NPI | 1437658960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 902847) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0993670-NP) |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2018-11-28 |