| NPI | 1710771423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 83596) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0104973) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 39348) | |
| 163W00000X Registered Nurse (Licence: TX 941746) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024193517) | |
| Enumeration Date | 2025-04-07 |
| Last Update Date | 2025-09-17 |