| NPI | 1598157570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CO APN.0998548-NP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 19673) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-08-14 |