| NPI | 1780484121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.1000783-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1674449) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2025-07-31 |