| NPI | 1801017702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0996543) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2026655) |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5870) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-11-09 |