| NPI | 1508433780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996430-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F345901-01) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-06-07 |