| NPI | 1710011689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0992754-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN179255) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2018-08-28 |