| NPI | 1538549811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C-APN.0002403-C-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 6370-33) |
| 363L00000X Nurse Practitioner (Licence: AZ 291336) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-05-23 |