| NPI | 1659402964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO RN-165625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95004120) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP2026672) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-09-26 |