| NPI | 1578702569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO 0995701) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MS 958096) |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2023-10-03 |