| NPI | 1659058097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 1000089-NP) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CO 1665218) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2025-10-30 |