| 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 |