| NPI | 1710375258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO A-APN.0000907-C-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02548) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2020-07-17 |