| NPI | 1548232606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO NP-5314) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO RN173147) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2022-02-09 |