| NPI | 1700413895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0001982-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015736) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-12-04 |