| NPI | 1639424146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 993437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 160115) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2025-04-04 |