NPI | 1639422801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0990472-NP) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02037) |
Enumeration Date | 2012-10-24 |
Last Update Date | 2023-11-27 |