| NPI | 1770964421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0999215-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO RXN.0108272-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP128301) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-12-27 |