| NPI | 1679295182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CO C-APN.0102503-C-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 905525) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2024-12-11 |