| NPI | 1679001036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0993212) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0993212-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201900239RN) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201900774NP-PP) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2023-01-27 |