| NPI | 1467030833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0996428) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO F03211191) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2021-04-08 |