| NPI | 1518683176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CO APN.0998629-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 95022772) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2024-04-09 |